Investigation of Follow-up Loss and Return Visit Characteristics in Neovascular Age-related Macular Degeneration Patients

Purpose: This study aimed to analyze the reasons for loss to follow-up (LTFU) in patients with neovascular age-related macular degeneration (nAMD) who received intravitreal anti-vascular endothelial growth factor injections and were lost to follow-up for more than 12 months.In addition, the clinical characteristics and visual changes of patients who returned for follow-up were investigated.Methods: A retrospective analysis was conducted on 74 of 319 patients diagnosed and treated for nAMD at a single tertiary center in Korea between 2017 and 2019 who experienced LTFU for more than 12 months.The causes of LTFU were identified through electronic medical records and telephone surveys.For the 13 patients who subsequently returned, clinical characteristics, best-corrected visual acuity (BCVA, logMAR), submacular hemorrhage, and involvement of the fellow eye were analyzed.Results: Among the 67 patients who responded to the telephone survey, the main reasons for LTFU were perceived futility of treatment (29.7%), distance or transportation difficulties (21.6%), and treatment at another hospital (18.9%).Of the 13 patients who returned, 11 (84.6%)showed significant worsening of BCVA in the treated eye, with the mean logMAR deteriorating from 0.68 to 1.05 (p = 0.026).In the fellow eye, 8 of 12 patients (66.7%) experienced vision loss, with mean logMAR worsening from 0.29 to 0.58 (p = 0.039).Submacular hemorrhage occurred in 6 patients (46%), and fellow-eye nAMD was observed in 7 patients (54%).Conclusions: LTFU in patients with nAMD can lead to vision loss and disease progression.In elderly patients and those living in rural areas, distance and transportation issues are major contributing factors.Continuous counseling and patient education are needed for those who perceive treatment as ineffective, and social measures to improve treatment accessibility are essential.